Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
PLoS One. 2022 Aug 15;17(8):e0272981. doi: 10.1371/journal.pone.0272981. eCollection 2022.
Diarrhoeal disease remains a leading cause of death among children mostly in low and middle-income countries. Factors contributing to disease severity are complex and there is currently no consensus on a scoring tool for use in community-based studies.
Data were collected during a passive surveillance system in an outpatient health facility in Lusaka, Zambia from March 2019 to July 2019. Diarrhea episodes were assessed for severity using an in-house severity scoring tool (CIDRZ) and previously published scores (Vesikari, Clark, CODA, and DHAKA). The CIDRZ score was constructed using fieldworker-reported clinical signs and exploratory factor analysis. We used precision-recall curves measuring severe diarrhoea (i.e., requiring intravenous rehydration or referred for hospital admission) to determine the best performing scores. Then, we used Cronbach's alpha to assess the scale's internal consistency. Finally, we used Cohen's kappa to assess agreement between the scores.
Of 110 diarrhea episodes, 3 (3%) required intravenous rehydration or were referred for hospital admission. The precision-recall area under the curve of each score as a predictor of severe diarrhoea requiring intravenous rehydration or hospital admission was 0.26 for Vesikari, 0.18 for CODA, 0.24 for Clark, 0.59 for DHAKA, and 0.59 for CIDRZ. The CIDRZ scale had substantial reliability and performed similarly to the DHAKA score.
Diarrhoea severity scores focused on characteristics specific to dehydration status may better predict severe diarrhea among children in Lusaka. Aetiology-specific scoring tools may not be appropriate for use in community healthcare settings. Validation studies for the CIDRZ score in diverse settings and with larger sample sizes are warranted.
腹泻病仍然是导致大多数中低收入国家儿童死亡的主要原因。导致疾病严重程度的因素很复杂，目前对于用于社区研究的评分工具尚无共识。
数据是 2019 年 3 月至 7 月在赞比亚卢萨卡的一家门诊医疗机构通过被动监测系统收集的。使用内部严重程度评分工具（CIDRZ）和先前发表的评分（Vesikari、Clark、CODA 和 DHAKA）评估腹泻严重程度。CIDRZ 评分是使用现场工作人员报告的临床体征和探索性因素分析构建的。我们使用精确召回曲线来衡量严重腹泻（即需要静脉补液或转至医院住院治疗），以确定表现最佳的评分。然后，我们使用 Cronbach's alpha 评估量表的内部一致性。最后，我们使用 Cohen's kappa 评估评分之间的一致性。
在 110 例腹泻发作中，有 3 例（3%）需要静脉补液或转至医院住院治疗。每个评分作为预测需要静脉补液或住院治疗的严重腹泻的准确性-召回曲线下面积分别为 Vesikari 为 0.26、CODA 为 0.18、Clark 为 0.24、DHAKA 为 0.59、CIDRZ 为 0.59。CIDRZ 量表具有较高的可靠性，与 DHAKA 评分表现相似。
专注于脱水状态特征的腹泻严重程度评分可能更能预测卢萨卡儿童的严重腹泻。针对病因的特定评分工具可能不适合在社区医疗保健环境中使用。需要在不同环境和更大样本量下对 CIDRZ 评分进行验证研究。
